The things you must know About Cirrhosis
The final stage of chronic liver disease is Cirrhosis. It results in distortion of the hepatic architecture by fibrosis, and the formation of regenerative nodules.
It is the result of progressive liver fibrosis caused by chronic liver diseases, including
- Viral hepatitis,
- Alcoholic liver disease,
- Non-alcoholic steatohepatitis (NASH),
- Autoimmune liver disease
- Genetic disorders amongst others.
Recent reports support the finding that the early stages of cirrhosis are reversible on a microscopic level with adequate treatment of the underlying liver disease. However, at more advanced stages, cirrhosis is considered irreversible. Cirrhosis is the source of a variety of complications, which result in a reduction in the life expectancy of these patients. At this stage, liver transplantation is the only curative treatment option.
Cirrhosis has a large burden of disease. It is the eighth leading cause of death and is responsible for 1.2% of all deaths in the USA. According to the Global Burden of Disease study, the worldwide prevalence of cirrhosis is increasing. In the USA, the most common causes of cirrhosis are chronic hepatitis C virus (HCV), alcoholic liver disease, and non-alcoholic liver disease. In Europe, liver cirrhosis accounts for 1.8% of all deaths, amounting to 170,000 deaths per year. Worryingly, the reported incidence of cirrhosis remains stable or is increasing in several countries, including both the UK8 and Ireland. In Europe, the main causes are alcoholic liver disease, NASH, and HCV.The four most frequent causes of cirrhosis worldwide are chronic hepatitis B virus (HBV) and HCV, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and haemochromatosis. A variety of other diseases can result in cirrhosis, although these are less frequent.
Clinical Features
Cirrhosis can be compensated without overt complications, or decompensated with the appearance of complications. The three major complications of cirrhosis are
- The consequences of portal hypertension (e.g. ascites, variceal bleeding, etc.),
- Hepatocellular insufficiency (e.g. icterus)
- The appearance of hepatocellular carcinoma (HCC).
Patients with compensated cirrhosis may present with nonspecific symptoms or may even be asymptomatic. They can complain of anorexia, weight loss, or fatigue. When decompensation develops, patients may present with jaundice, pruritus, signs of upper gastrointestinal bleeding, abdominal distension due to ascites, or confusions due to hepatic encephalopathy. Hypogonadism may occur in men, which can manifest as impotence, infertility, or loss of libido. In women, amenorrhoea or irregular menstrual bleeding are common.Typical signs at clinical examination include jaundice, stellate angiomas, palmar erythema, foetor hepaticus, asterixis, signs of hypogonadism, and feminisation in males. Other signs include indicators of portal hypertension such as ascites, cutaneous collateral venous circulation, and splenomegaly.
Symptoms of Early Stage
- Blood Capillaries become visible on the Skin
- Insomnia
- Itchy Skin
- Nausea
- Loss of appetite
- Feel Weakness
- Fatigue
Symptoms of in Progress Cirrhosis
- Bleeding Gums
- Confusion
- Dizziness
- Cramps on the muscle
- Darker urine
- Changes of personality
- Accelerated Heartbeat
- Hair loss
- Nose bleeds
- Vomit the blood
Prevention of Complication and Treatment.
The presence of impaired hepatic metabolism and renal excretion denotes a need for caution with many medications, which may subsequently necessitate dose adjustments or should even be avoided. Nephrotoxic agents can precipitate HRS and should be used cautiously. Careful monitoring for the development of complications and, if possible, the prevention of complications, is the cornerstone of the treatment of a cirrhotic patient. Cirrhotic patients should undergo screening for oesophageal varices with upper endoscopy. However, according to the recent Baveno VI guidelines, patients with a liver stiffness 150,000 can avoid screening. Patients with medium or large varices require primary prevention with non-selective beta blockers or endoscopic band ligation. The role of carvedilol remains unclear. Furthermore, platelet levels <100,000 can increase risk for surgery.
The presence of hepatic encephalopathy can be extremely subtle. Precipitating factors including dehydration, infection, and variceal bleeding should be avoided or addressed as soon as possible. The ultimate treatment for cirrhosis is liver transplantation, and excellent long-term results have been demonstrated.It should be considered in patients with decompensated cirrhosis. The final decision depends upon the severity of the liver disease and the absence of contraindications.
Patients who develop Hepatocellular carcinoma (HCC) should be managed according to the Barcelona Clinic Liver Cancer (BCLC) staging system. Single HCC lesions in Child–Pugh A patients are eligible for resection or ablation. Intermediate stage disease patients are offered locoregional therapy including transarterial chemoembolisation or radioembolisation. In advanced or metastatic disease, sorafenib is the only remaining option. it improves median overall survival from 6 to 9 months.
